Vaccination of Diphtheria

Diphtheria once was a major cause of illness and death among children. Diphtheria death rates range from about 20% for those under ages five and over age 40, to 5-10% for those aged 5-40 years. Death rates were likely higher before the 20th century. Diphtheria was the third leading cause of death in children in England and Wales in the 1930s.

Since the introduction of effective immunization, starting in the 1920s, diphtheria rates have dropped dramatically in the United States and other countries that vaccinate widely. Between 2004 and 2008, no cases of diphtheria were recorded in the United States. However, the disease continues to play a role globally. In 2007, 4,190 cases of diphtheria were reported.

Transmission and Symptoms

Diphtheria is transmitted from person to person, usually via respiratory droplets. The infection is caused by bacteria called Corynebacterium diphtheriae. An infected person, unless treated with antibiotics, is infectious for two to three weeks. Symptoms include sore throat, loss of appetite, and fever. The most notable feature of diphtheria infection, however, is the formation of a thick gray substance called a pseudomembrane over the nasal tissues, tonsils, larynx, and/or pharynx.

The pseudomembrane sticks to tissues and may obstruct breathing. The toxin itself may travel to the heart, muscle, kidneys, and liver, where it may temporarily or permanently damage these organs.

Diphtheria vaccination

In total, children should receive five doses of the diphtheria vaccination. It's usually combined with other vaccines. For most people, five doses provide a good level of protection against diphtheria for the rest of their life.

Babies: All babies are offered vaccination against diphtheria as part of the 5-in-1 vaccine that is given when they're two, three and four months old. The 5-in-1 vaccine, also known as the DTaP/IPV/Hib vaccine, also protects against: Tetanus, whooping cough, polio and Hib (Haemophilus influenzae type b).

Pre-school children: A booster vaccine against diphtheria is given as part of the 4-in-1pre-school booster (also called the DTaP/IPV vaccine) to children who are about three years and four months old. The 4-in-1 vaccine protects against diphtheria, tetanus, whooping cough and polio.

Teenagers: A final booster dose of diphtheria vaccine is given as part of the 3-in-1 teenage booster (also called the Td/IPV vaccine) to children when they're 13 to 18 years old. Th 3-in-1 vaccine protects against diphtheria, tetanus and polio.

Travel vaccination against diphtheria: Further booster diphtheria vaccinations may be required if you're going to live or work in parts of the world where diphtheria is widespread. You should have a booster dose if your last dose was more than 10 years ago.

Regions known to have high rates of diphtheria include:

·         Sub-Saharan Africa (all the countries south of the Sahara Desert, particularly Nigeria)

·         India

·         Nepal

·         Bangladesh

·         Indonesia

·         Philippines

·         Vietnam

·         Laos

·         Papua New Guinea

·         Brazil

·         Iraq

·         Afghanistan